WO2017001271A1

WO2017001271A1 - Medical instrument, particularly a uterine manipulator

Info

Publication number: WO2017001271A1
Application number: PCT/EP2016/064506
Authority: WO
Inventors: Michael Wolter; Uwe SCHÖLER; Lena WILKER
Original assignee: Olympus Winter & Ibe Gmbh
Priority date: 2015-07-02
Filing date: 2016-06-23
Publication date: 2017-01-05
Also published as: DE102015212379A1

Abstract

The invention relates to a medical instrument (10), particularly a uterine manipulator (10), comprising a shaft (12) with a longitudinal axis and a securing device provided at the distal end of said shaft (12) for the purpose of securing tissue, particularly cervical tissue, said securing device having at least one movable securing body (18) for securing the tissue. The medical instrument (10) is characterised in that, when a displacement device is actuated, the securing body (18) is or can be displaced in parallel in a plane perpendicular to the longitudinal axis of the shaft (12), by means of the displacement device.

Description

Medical instrument, especially uterine manipulator Description

The invention relates to a medical instrument, in particular a uterine manipulator, having a shaft and a fixing device for fixing tissue, in particular cervical tissue, provided at the distal end of the shaft, wherein the fixing device has at least one movable fixation body for fixing the tissue.

Medical tools for uterine manipulation are used in gynecological surgery in laparoscopic hysterectomy to mobilize the uterus or during chromo-subduction. In such surgical procedures, it is important to avoid relative movement of the manipulator and uterus or cervix.

For example, DE 1 0 2006 01 6 002 A1 describes a device for carrying out examinations and surgical interventions on a uterus. Based on this prior art, the object of the invention is to provide a medical instrument, such as a uterine manipulator, which is easy to handle during surgical procedures and can be securely fixed to a uterus in a simple manner.

This object is achieved by a medical element, in particular a uterine manipulator, having a shaft having a longitudinal axis and a fixing device for fixing tissue, in particular cervical tissue, provided at the distal end of the shaft, wherein the fixing device has at least one movable fixation body for fixing the tissue is further developed that the at least one fixing body is displaceable parallel to the longitudinal axis of the shaft by means of a displacement device upon actuation of the displacement device in a vertical plane or is displaced.

The invention is based on the idea that the medical instrument for manipulating a uterus has an elongated shaft, wherein at the distal end of the shaft fixing body of a fixing device for fixing tissue are provided, wherein the fixing body or bodies with respect to the longitudinal axis of the shaft by means of a Displacement device are displaced in parallel in the vertical plane to the longitudinal axis of the shaft or moved. In particular, the fixing bodies are designed as fixing pins, wherein the longitudinal axes of the fixing pins are arranged or aligned parallel to the longitudinal axis of the shaft of the medical instrument.

Due to the parallel displacement of the fixation body or the fixation body, the radial distance of the fixation body to The longitudinal axis of the shaft varies or adjusted, whereby a fixation of the medical instrument, for example, is achieved on a uterus in a simple manner.

In addition, it is provided in a development of the medical instrument that several fixation body at the same time parallel to the actuation of the displacement device, in particular parallel to each other, are displaced or moved. Thereby, the distance between the fixation bodies, which are in particular designed as fixing pins, adjusted accordingly.

In addition, an embodiment of the medical instrument is characterized in that the displacement device for the fixation body has a Longworth chuck ("Longworthchuck").

A so-called Longworth chuck has two mutually rotatable discs, wherein the discs circular arc-shaped tracks as guideways for the fixation body or for the fixing pins, wherein the circular arc-shaped tracks are milled, for example, in the discs. Here, the embodiment or the formation of the circular arc-shaped paths for the fixation body is identical for both discs. In order to achieve a secure guidance of the fixation body, one of the two discs is rotated, so that the circular arc-shaped guideways of the two superimposed discs intersect. By the relative rotational movement of the two circular discs to each other, the distance of the fixing body can be varied to the center axis of the discs. The center axes of the discs of the Longworth chuck are arranged collinear to the longitudinal axis of the shaft. By using the Longworth chuck, the fixation bodies are arranged uniformly, in particular symmetrically, so that self-centering of the instrument on the tissue to be fixed is achieved with the relative rotation of the two discs relative to one another.

In order to rotate the disks of the Longworth chuck against each other, for example, between the two disks a face plate ring or the like is arranged.

Moreover, in a further development of the medical instrument, it is preferred that a disc of the Longworth chuck is rotatable by means of an actuating device, preferably arranged at the proximal end of the shaft.

For this purpose, it is further provided that the actuating device comprises a rotary grip provided at the proximal end of the shaft, wherein in particular the rotary handle is connected to a disc of the Longworth chuck. In this case, for example, the rotary handle via a connecting member, such. a rod or pipe connected to a disk of the Longworth chuck. In particular, the connecting tube or the connecting rod is received as a connecting member in the shaft of the medical instrument. By turning the Verbindungsgl iedes on the rotary handle is also rotated in accordance with a disc of Longworth chuck, so that a relative rotational movement of the two discs of the Longworth chuck is carried out and thereby the fixing body or pins are moved parallel to each other.

Characterized in that the actuating device can be locked or locked by means of a, preferably proximal, locking device or, accidental or inadvertent release or opening of the fixation device from the fixed tissue is avoided. For example, if the actuator is designed as a connecting member or rotary tube or the like, in one embodiment, a locking device or clamping device, preferably proximally provided to lock or clamp the connecting member or the rotary tube in a locking position after setting a fixing position of the fixing device or to lock. In this case, it is possible, for example, for the locking to be formed on the rotary handle of the actuating device or of the connecting member proximally. In particular, the fixing device is locked in a manual manner. Also, the release of the locking of the fixing device can also be done by manual operation.

Furthermore, according to a preferred embodiment of the medical instrument, it is provided that a cervical cap is provided at the distal end of the shaft, wherein at least one or more fixation bodies and / or the displacement device for the fixation bodies are accommodated in the cervical cap.

In addition, a preferred embodiment of the medical instrument is distinguished by the fact that the fixing body or bodies, preferably at the free end, have a fixing projection. This makes it possible that the fixing pins designed as fixing body are designed as Tenaculum and at the free end of the fixing pins corresponding tips are provided for fixing the tissue.

Further, in the medical instrument, it is preferable that at the distal end of the shaft, there is a projection formed in a channel a cervix can be introduced, is arranged.

Further features of the invention will become apparent from the description of embodiments according to the invention together with the claims and the accompanying drawings. Embodiments of the invention may satisfy individual features or a combination of several features.

The invention will be described below without limiting the general inventive idea by means of embodiments with reference to the drawings, reference being expressly made to the drawings with respect to all in the text unspecified details of the invention. Show it :

Fig. 1 a schematically shows a view of a uterine manipulator with an opened fixing device and

Fig. 1 b is a schematic view of the uterine manipulator with a closed position of the fixing device;

Fig. 2a schematically shows a plan view of a disc of a

Longworth chucks and

Fig. 2b schematically shows a view of a second disc of the

Longworth chuck.

In the drawings, the same or similar elements and / or parts are provided with the same reference numerals, so that apart from a new idea each.

FIGS. 1 a and 1 b show schematic views of a uterine manipulator 10 as a medical instrument, which an elongate shaft 1 2 has. At the distal end of the shaft 12, a cervical cap 14 is arranged, which is placed at the cervix of a uterus in the intended use of the uterine manipulator 10.

To arrange the cervical cap 14 on a cervix of a uterus, an extension 16 is arranged at the distal end of the shaft 1 2, which is insertable into the channel of the uterus. In order to fix the cervical cap 14 to the uterus or the cervix for surgical intervention, the uterine manipulator 10 has fixing pins 18 at the distal end, which are displaceable in parallel by means of a Longworth chuck 20. By means of the Longworth chuck 20, the fixing rods 18 are moved in a plane perpendicular to the longitudinal axis of the shaft 12, wherein the fixing rods 1 8 are offset parallel, so that by operating the Longworth chuck 20, the radial distance of the fixing rods 1 8 to the center axis or The longitudinal axis of the shaft 12 is varied or adjusted.

In order to achieve a secure hold of the fixing rods 18 on the cervix, 1 8 tips 22 are provided at the free end of the fixing rods, so that when touching the tips 22 on the cervical tissue, the cervical cap 14 is securely arranged. In particular, the tips are designed as Tenaculum.

To adjust the diameter or the radial distance of the fixing pins 18 to the longitudinal axis of the shaft 12, the Longworth chuck 20 or a disc of the Longworth chuck 20 is connected to a rotatably mounted rotary tube 24 in the interior of the shaft 12, so that the rotary tube 24 at the proximal end of the shaft 1 2 is palpable. By turning the rotary tube 24 is a disc of Longworth chuck 20 relative to the stationary rotated, whereby the distance of the fixing pins 18 is adjusted accordingly.

Preferably, the rotary tube 24 is formed at the proximal end with a rotary handle or the like, whereby the Longworth chuck 20 can be adjusted manually.

The rotary tube 24 is formed as a kind of actuator for the Longworth chuck 20, wherein for locking the Longworth chuck 20 and the fixing rods 18 to a tissue to be fixed at the proximal end of the rotary tube 24, a preferably manually operable latch button 25 is provided , After fixing the tissue and actuation of the locking knob 25, the rotary tube 24 is secured against accidental rotation. To release the locking position of the latch button 25 is pressed again.

Fig. 2a, a top view of an upper disc 26 of the Longworth chuck 20 is shown schematically. In Fig. 2b, a lower disc 28 of the Longworth chuck 20 is shown schematically. The Longworth chuck 20 here comprises the upper disc 26 and the lower disc 28. The upper disc 26 comprises four uniformly arranged arcuate paths 36 for the fixing pins 18th

The fixing pins 18 are also also guided below the disc 26 arranged second disc 28 in the circular arc paths 38, so that upon rotation of the discs 26, 28 relative to each other, the fixing pins 1 8 are moved simultaneously in the radial direction. The circular arc trajectories 36 of the disc 26 and the circular arc paths 38 of the disc 28 are in normal arrangement above each other and intersect, whereby a radial guidance of the fixing pins 1 8 is made possible. By the relative rotation of the Discs 28 and 26, the fixing pins 1 8 are moved radially evenly and self-centering.

By means of the uterine manipulator 10 according to the invention, it is possible in a total laparoscopic hysterectomy to fix the cervical cap 14 in a simple manner and to arrange it by means of the setting centering by means of the Longworth chuck 20, whereby a relative movement between the uterine manipulator 10 and a uterus or a Cervix is avoided.

LIST OF REFERENCE NUMBERS

1 0 uterine manipulator

1 2 shaft

14 cervical cap

1 6 extension

1 8 Fixing rod

20 Longworth chucks

22 tip

24 rotary tube

25 detent button

26 disc

28 disc

36 circular arc

38 circular arc

Claims

claims

1 . Medical instrument (10), in particular a uterine manipulator (10), with a shaft (12) having a longitudinal axis and a fixing device for fixing tissue, in particular cervical tissue, provided at the distal end of the shaft (12), wherein the fixing device comprises at least one movable fixation body (18) for fixing the tissue, characterized in that the fixing body (18) is displaceable by means of a displacement device in operation of the displacement device parallel in a vertical plane to the longitudinal axis of the shaft (12) or is displaced.

2. Medical instrument (1 0) according to claim 1, characterized in that a plurality of fixing body (1 8) at the same time parallel to the operation of the displacement device, in particular parallel to each other, are displaced or moved.

3. Medical instrument (1 0) according to claim 1 or 2, characterized in that the displacement device for the fixing body (18) has a Longworth chuck (20).

4. Medical instrument (1 0) according to claim 3, characterized in that the Longworth chuck (20) has two relatively rotatable and with circular arc paths (36, 38) provided with discs (26, 28).

5. Medical instrument (1 0) according to claim 4, characterized in that a disc (26, 28) of the Longworth chuck (20) by means of a preferably arranged at the proximal end of the shaft (1 2), the actuating device is rotatable.

6. Medical instrument (1 0) according to claim 5, characterized in that the actuating device comprises a at the proximal end of the shaft (1 2) provided rotary handle, wherein in particular the rotary handle with a disc (26, 28) of the Longworth chuck connected is.

7. Medical instrument (1 0) according to claim 4 or 5, characterized in that the actuating device can be locked or is locked by means of a, preferably proximal, locking device or is.

8. The medical instrument (10) according to any one of claims 1 to 7, characterized in that at the distal end of the shaft (1 2) a cervical cap (14) is provided, wherein in the cervical cap (14) at least one or more Fixation body (1 8) and / or the displacement device for the Fixation body (1 8) are included.

9. Medical instrument (1 0) according to one of claims 1 to

8, characterized in that the one or more fixing body (1 8), preferably at the free end, a fixing projection (22).

10. Medical instrument (1 0) according to any one of claims 1 to

9, characterized in that at the distal end of the shaft (1 2) an extension (1 6), which is insertable into a channel of a cervix, is arranged.